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Infections within the scrotum are readily treatable if diagnosed quickly. If left undiagnosed and untreated, the infections can advance to severe consequences. The specialists at the Glickman Urological and Kidney Institute are experts at treating all urological infections including all sexually transmitted diseases.
How frequent are these infections?
Epididymitis affects somewhat less than 1 of every 1,000 males each year. Orchitis may result as a secondary infection stemming from epididymitis or it may be a primary (de novo) infection that starts in the testicle. This infection, also called acute orchitis, is frequently associated with mumps. About 30% of young boys with mumps will develop orchitis.
Symptoms include scrotal swelling (enlarged testicles), a tender or heavy feeling in the testicle that is affected, fever, discharge from the penis, and pain with urination, during intercourse, or with ejaculation. Additional symptoms include groin pain, blood in the semen, and a lump in the testicles.
Important: Acute testicular pain and/or swelling may result from testicular torsion – a twisted testicle. This is an emergency medical situation and immediate care should be sought from the nearest medical facility or emergency room.
The infections that strike within the scrotum usually involve the epididymis and/or testicles. The epididymis is a slender, convoluted structure lying on the backside of each testicle. It serves as a reservoir where sperm mature.
Epididymitis is an inflammation of this structure resulting from infection with a bacteria or virus. Orchitis is an inflammation of the testicles resulting from infection, usually transmitted from the epididymis. When both structures are infected, a not unusual event, the disease is called epididymo-orchitis.
A number of bacteria and viruses cause the infections in the scrotum. A substantial percentage of epididymis/orchitis is caused by sexually transmitted diseases (STDs) such as chlamydia and gonorrhea. The incidence of STDs is skyrocketing in the U.S. Chlamydia is responsible for about half or more of epididymis cases in men 35 or younger. Gonorrhea is the second most common cause. Bacteria that commonly cause orchitis include Escherichia coli, Staphylococcus, and Streptococcus.
Chronic orchitis may be due to tuberculosis, syphilis, or a condition known as non-specific granulomatous change. This is a change that describes the granulated tissue that forms during healing as a result of injury, inflammation or infection. In young prepubertal boys and in men 35 and older, epididymis is often caused by coliform bacteria, a germ normally found in the intestines. Tuberculosis epididymo-orchitis is usually associated with renal (kidney) tuberculosis. Some of the more rare viral causes of orchitis include Coxsackie virus, infectious mononucleosis, varicella and echovirus.
Diagnosis includes a physical examination, laboratory testing, and often imaging studies. The physical examination will include palpation (feeling) of the scrotum to localize the source of pain, identify swelling of the affected testicle, and to detect any suspicious lumps. The exterior of the scrotum will be examined for any appearance of infection. A rectal examination is conducted as some cases of epididymis/orchitis have been related to prostatitis.
Laboratory tests include urinalysis and a urine culture. This test involves putting a small sample of urine in a growth medium to identify the bacteria that may grow. Determining the species of bacteria that are present will help the treating physician choose an appropriate therapy. There will also be a urethral smear, a procedure in which a sample of fluid is acquired by inserting a small swab in the urethra. The sample is used to culture bacteria.
The imaging study is usually sonography. Sonography bounces sound waves off of tissues and structures and uses the echoes to form an image, a sonogram. If an infection is present, the sonogram may show increased blood flow to the infected area. Sonography is also used to rule out testicular torsion.
Broad-spectrum antibiotics are used to treat these infections. They are called “broad-spectrum” because they destroy a range of bacteria. Analgesics are prescribed to help control pain that may be associated with the infections. Bed rest, elevation of the scrotum and ice packs are recommended for comfort. The pain should resolve within 3 to 4 days.
Patients diagnosed with STDs (chlamydia or gonorrhea) should have their sexual partners tested and treated if necessary. They should also take an HIV test. The patient returns after 3 to 7 days of treatment for lab testing to insure that the infection has been eradicated. Unfortunately there are no effective medications for viral infections as yet.
Most cases of orchitis and epididymitis will resolve without complications but a percentage of patients may need hospitalization. These are those with intractable pain; those with nausea or vomiting that inhibit oral medications; those with evidence of an abscess; those who fail to improve after 72 hours of outpatient treatment, and those who are immunocompromised with significant symptoms.
Orchitis/epididymis are readily treatable infections if diagnosed quickly but if left undiagnosed and untreated, the infections can advance to severe consequences. If any symptoms are experienced, please consult a urologist immediately for an examination.